I'm Planning Upper Eyelid Surgery, So What Do You Mean by Ptosis?

Hello, this is Park Sung-hyuk from Nunhight Plastic Surgery.

Among the upper eyelid surgery patients who visit our clinic,

many also have ptosis,

so it is common for us to recommend ptosis surgery...

A common pair of eyes you might see around you in people in their 50s to 60s

I’d like to introduce in a little more detail

what ptosis treatment is,

and why it is needed in middle-aged eye surgery.

What is ptosis surgery?

Ptosis is when the eye-opening strength is weak, so the dark part of the eye is covered a lot.

It is often called sleepy eyes...

If about 1/3 of the dark part is covered, the eyes look sleepy.

The treatment for this is

ptosis correction (= eye-opening correction, ptosis surgery)

.

The reason I recommend eye-opening correction in eye surgery after the 40s is

because of age-related changes...

1. Eye anatomy

The structure of the eye

To understand sleepy-eye symptoms,

it is important to understand the relationship between the muscle that opens the eye and the tarsal plate.

● Tarsal plate: Located in the upper and lower eyelids; it is cartilage.

● Levator muscle: The muscle that opens the eyes.

Seen from the side, it looks like this.

Side view of the eye structure

If we show only the eye-opening muscle and the tarsal plate, it looks like this below.

The levator muscle is marked in blue, and the tarsal plate is marked in red.

Normally, the eye-opening muscle should be attached to the tarsal plate.

2. Aging of the levator muscle

When this connection weakens due to aging,

even if the eye-opening muscle contracts strongly,

the tarsal plate does not rise as much as desired,

so the eye opens less.

As people age, the connection area (green) weakens.

Although it weakens with age,

there are individual differences based on innate traits,

so if the eye-opening strength was strong from a young age,

there may be no ptosis even in the 60s or 70s.

On the other hand, if the strength is weak,

the muscle may be detached from the tarsal plate even at a young age (teens to 20s).

-Ptosis surgery video-

3. How ptosis is treated

Correcting sleepy eyes means

strengthening the weakened connection again.

Schematic diagram of ptosis surgery

And because the incision site is the same for ptosis surgery,

it can be performed at the same time as double-eyelid surgery,

which may be why people often get confused about it,

and it also seems to be interpreted in different ways depending on each person’s situation (link).

3. Is ptosis covered by insurance?

For insurance to apply, the pupil must be covered by half,

but in fact, symptoms at this level make daily life difficult.

Many people think ptosis is not covered by insurance at a plastic surgery clinic,

but is covered at an ophthalmology clinic...

Strictly speaking, this happens because the more severe the functional impairment,

patients are more likely to visit ophthalmology first,

which creates selection bias.

In other words, because the focus is on the functional aspect,

severe patients go to ophthalmology and receive insurance coverage,

while mild patients do not want to miss the aesthetic aspect either,

so they come to Gangnam plastic surgery clinics.

Among those who come to plastic surgery clinics,

the eyelid skin almost never invades the pupil,

so it is considered for cosmetic improvement and is not covered by insurance.

However, if it is covered by insurance due to functional impairment,

the out-of-pocket cost for the patient’s ptosis surgery is around 300,000 to 400,000 KRW.

4. Upper eyelid surgery review

Below are cases from our Nunhight Plastic Surgery clinic in Gangnam...

1. If I open my eyes with my forehead, do I need eye-opening correction?

So many people think

opening the eyes with the forehead

=

ptosis

like this.

It is not an exact formula, but

there is some connection.

2 months after eye-opening correction

This patient came in considering upper and lower eyelid surgery, and we persuaded them that ptosis correction was necessary...

Before surgery, they used their forehead to open their eyes,

but after surgery, they no longer need to use their forehead,

so the eyebrow shape looks much more natural and relaxed.

2. The eyelid hollow is severe, but the double eyelids are high

Before-and-after ptosis treatment

This patient in their 60s came to see me because the eyelids had sagged.

In fact, the sagging is mild.

So while making the double eyelid line lower,

we also improved both the hollow above the eyes and the sleepy-eye appearance through eye-opening correction.

3. Upper eyelid revision surgery

The case below is the sister of the patient above,

and because the result was good, the older sister also came to Nunhight.

2 months after upper eyelid revision surgery

She wanted to correct the high double eyelid line that appeared after surgery 30 years ago,

and even though the surgery only lowered the double eyelid line and performed eye-opening correction,

the result feels much younger and aesthetically clearer.

If eye-opening correction had not been performed,

the eyelid would still have covered 1/3 of the pupil.

4. Is ptosis surgery necessary?

Before and after ptosis correction

This is a case where the eyeliner tattoo is large, so the double eyelid line needs to be made lower,

and patients like this are also commonly seen around us.

While setting the line lower, ptosis treatment was performed so that more of the dark part of the eye could be exposed.

5. How much bigger can the eyes get with eye-opening correction?

Forehead lift + upper eyelid surgery + ptosis surgery

Another Nunhight patient.

Previous image Next image

Before surgery and 2 weeks after

In fact, this patient’s eye-opening function before surgery was only 8 mm, which was too low.

If only eye-opening correction had been done, it would not have improved this much,

but because a forehead lift was performed at the same time,

it reduced the burden on the eye-opening muscle,

and I think that is why it improved so much.

For reference, the function of the eye-opening muscle can be evaluated before ptosis surgery.

However, this is only a prediction that can be made before surgery,

and it does not correspond exactly to the result.

5. Conclusion

Did you notice something common in the cases above?

As an eye-surgery specialist, the common features I see in today’s cases (link) are

sunken eyes,

high double-eyelid lines,

and sleepy eyes.

These three symptoms

are typical appearances that occur when the tarsal plate and levator muscle become separated,

and they are commonly seen in middle-aged eyes.

Therefore,

ptosis correction surgery

becomes more necessary as people age,

so it is something to keep in mind when having upper eyelid surgery.

If you are looking for a place that is good at middle-aged eye plastic surgery,

Click the KakaoTalk consultation button right now!

Nunhight Plastic Surgery, located between Gangnam Station and Sinnonhyeon Station,

is equipped with both public transportation access and parking facilities. ​